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Preventive and Community Medicine in Primary Care

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Preventive and Community Medicine in Primary Care RA . _ 44- 0 . 6 A111 1973 X Uk I WA, MW) : Of? BmLTJtf, EDW^TIQN, AJN» WELFARE i/fllh f?ervfct< Vt*/iro HP ss e A I PM//-o^arJy, £ir*j?4Stury7 ^re Ve +J -/n PREVENTIVE AND COMMUNITY MEDICINE IN PRIMARY CARE A Conference Sponsored by The John E. Fogarty International Center for Advanced Study in the Health Sciences and the Association of the Teachers of Preventive Medicine National Institutes of Health Bethesda, Maryland William H. Barker, M.D. Editor DHEW Publication No. (NIH) 76-879 U.S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE Public Health Service National Institutes of Health { Hr4'&.£ u\ \°\ r , 3 A > For Sale by the Superintendent of Documents, U.S. Government Printing Office Washington, D.C. 20402— Price $4.90 (cloth) Stock Number 017-053-00051-5 This monograph is the fifth in a series on the TEACHING OF PREVENTIVE MEDICINE sponsored by the John E. Fogarty International Center for Advanced Study in the Health Sciences and the Association of Teachers of Preventive Medicine PARTICIPANTS AND CONTRIBUTORS Dr. Herbert K. Abrams, Department of Family and Community Medicine, College of Medicine, The University of Arizona, Tucson, Arizona Dr. Len H. Andrus, Department of Family Practice, University of California, Davis, School of Medicine, Davis, California Dr. Richard M. Baker, Department of Family Medicine, University of Washington, School of Medicine, Seattle, Washington Dr. William H. Barker, Department of Preventive Medicine and Community Health, School of Medicine and Dentistry, University of Rochester, Rochester, New York Dr. Robert L. Berg, Department of Preventive Medicine and Community Health, School of Medicine and Dentistry, University of Rochester, Rochester, New York John Braun, Bureau of Health Resources Development, Atlanta, Georgia Dr. Valerie Buyse, Department of Family and Community Medicine, University of Arizona, College of Medicine, Tucson, Arizona Dr. C. Hilmon Castle, Department of Community and Family Medicine, University of Utah, College of Medicine, Salt Lake City, Utah Dr. Cora Christian, Howard University, College of Medicine, Washington, D.C. Dr. Leslie A. Falk, Department of Family and Community Health, Meharry Medical College, School of Medicine, Nashville, Tennessee Dr. Eugene Farley, Department of Community Medicine, University of Rochester, School of Medicine and Dentistry, Rochester, New York Dr. Count Gibson, Department of Community and Preventive Medicine, Stanford University, School of Medicine, Stanford, California Dr. Gordon Hall, Rockford School of Medicine, University of Illinois, Rockford, Illinois Dr. Rugh Henderson, Department of Family and Community Medicine, College of Medicine, Pennsylvania State University, Hershey, Pennsylvania Ms. Susan M. Horowitz, National Physicians Assistants Program, Bureau of Health Resources, Bethesda, Maryland Dr. James I. Hudson, Director, Department of Health Services, Association of American Medical Colleges, Washington, D.C. Dr. William L. Kissick, Department of Community Medicine, University of Penn- sylvania, School of Medicine, Philadelphia, Pennsylvania Dr. William E. Matory, College of Medicine, Howard University, Washing- ton, D.C. Dr. Fred R. McCrumb, Jr., Special Assistant to the Director, Fogarty International Center, National Institutes of Health, Bethesda, Maryland Dr. Ian McWhinney, The University of Western Ontario, Faculty of Medicine, London, Ontario, Canada Dr. Louis Miller, Department of Social and Preventive Medicine, University Hospital, Baltimore, Maryland v vi / Prevention in Primary Care Dr. Charles Payton, University of Rochester, School of Medicine and Dentistry, Family Medicine Program, Rochester, New York Dr. F. Douglas Scutchfield, Office of the Field Professor, Department of Com- munity Medicine, University of Kentucky, Morehead, Kentucky Dr. Stephen Smith, University of Rochester, School of Medicine and Dentistry, Family Medicine Program, Rochester, New York Dr. Vernon Smith, Howard University, College of Medicine, Washington, D.C. Dr. Joseph Stokes III, Department of Community Medicine, University of Cali- fornia, San Diego, School of Medicine, La Jolla, California Dr. Jesse W. Tapp, Department of Family and Community Medicine, University of Arizona, College of Medicine, Tucson, Arizona Dr. George Thomson, Department of Preventive Medicine, The Medical College of Wisconsin, Milwaukee, Wisconsin Dr. Venita Thweatt, 6319 Landover Road, Cheverly, Maryland Dr. Donald F. Treat, Department of Community Medicine, University of Roches- ter, School of Medicine and Dentistry, Rochester, New York Dr. James E. C. Walker, Department of Community Medicine and Health Care, University of Connecticut, School of Medicine^ Farmington, Connecticut PREFACE The Fogarty International Center was established in 1968 as a memorial to the late Congressman John E. Fogarty from Rhode Island. It had been Mr. Fogarty’s desire to create within the National Institutes of Health a center for research in biology and medicine dedicated to international cooperation and collaboration in the interest of the health of mankind. The Fogarty International Center is a unique resource within the Federal establishment, providing a base for expansion of America’s health research and health care to lands abroad and for bringing the talents and resources of other nations to bear upon the many and varied health problems of the United States. As an institution for advanced study, the Fogarty International Center has embraced the major themes of medical education, environmental health, societal factors influencing health and disease, geographic health problems, international health research and education, and preventive medicine. Our commitment to the study of preventive aspects of human disease is expressed in the forthcoming Fogarty International Center Series on Preventive Medicine. Improvement in the health status of the American people will depend, in great measure, on the design and application of programs which place major emphasis on the preventive aspects of human disease. Although health authorities generally agree with this thesis, there is need for more precise definition of effective methods and programs of prevention, financial resources required to implement these pro- grams, and priorities to be assigned to research in preventive methodology. The need to assemble expertise in this field to elucidate mechanisms whereby the full impact of preventive medicine may be brought to bear on the solution of America’s major health problems has been expressed repeatedly in public statements by leaders throughout the health field. In response to this need, the Fogarty International Center initiated a series of comprehensive studies of preventive medicine in order to review and evaluate the state of the art of prevention and control of human diseases, to identify deficiencies in knowledge requiring further research, including analysis of financial resources, preventive techniques, and manpower, and to recognize problems in application of preventive methods and suggest corrective action. In an effort to contribute to the educational aspects of preventive medicine, the Fogarty International Center has undertaken a cooperative program with the Association of Teachers of Preventive Medicine to create resource material to assist in the administration, teaching, research, and service responsibilities among departments of preventive medicine, to enhance collaborative activities between departments of preventive medicine and other academic units of health science schools, and to propose national programs of teaching, research, and service in preventive medicine. Topics to be given major emphasis include the role of behavioral sciences in preventive medicine, academic relationships between depart- ments of preventive medicine and schools of public health, international and viii /Prevention in Primary Care extramural teaching and research opportunities in preventive medicine, teaching resources of departments, health education, primary care and family medicine, the role of ancillary health personnel in the health care delivery systems, and consumer participation in health care delivery. This monograph on Preventive and Community Medicine in Primary Care is part of the Fogarty International Center Series on the Teaching of Preventive Medicine. The growing emphasis on preventive services has focused attention on the interests and responsibilities shared by practitioners of primary care and pre- ventive medicine specialists. It is obvious that the knowledge developed in preven- tion research will be applied in practice through the primary care disciplines of family medicine, pediatrics, internal medicine and obstetrics. Accordingly, it will be necessary for the educational process to promote the integration of these dis- ciplines with preventive medicine teaching in the development of new knowledge, the delivery of preventive services and evaluation of the health care system. This monograph attempts to analyze ways in which this integration can be accomplished. Milo D. Leavitt, Jr., M.D. Director Fogarty International Center CONTENTS Page PARTICIPANTS AND CONTRIBUTORS v A Note from the Chairman Herbert K. Abrams xi INTRODUCTION William H. Barker xiii RECOMMENDATIONS FROM THE CONFERENCE xxi MEDICAL SCHOOL ASPECTS Chapter 1 Roles of Departments of Preventive Medicine Jesse W. Tapp 3 INVITED DISCUSSION C. Hilmon Castle 9 DISCUSSION 13 CONTENT AND METHODS Chapter 2 Competency-Based Objectives in Preventive Medicine for the Family Physician Richard M. Baker 23 INVITED DISCUSSION
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